My Apartment in Virginia

For the first 2 weeks of my assignment, I lived at the Towneplace Suites Marriott hotel. My stay was enjoyable because I had a full kitchen, free breakfast, and was able to accumulate more Marriott Rewards points.

In the mean time I was provided with a couple of apartment options and visited the apartments before narrowing them down to one. The apartment I selected was a 2 bedroom/2 bathroom furnished apartment. It was nice because the agency had the entire apartment filled with everyday items such as dishes, towels, bed linen, pillows, a television, etc. Since I often stay at Airbnbs or hotels, I do not typically travel with these items, so it was great that I didn’t have to worry about obtaining them. Once you start jotting down all of the household items you need to travel with, it starts to accumulate.

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I am usually pretty open to housing options when working locum tenens. I think the most important thing to me is having a kitchen, especially for longer assignments. Be sure to ask about your housing options BEFORE you accept an assignment. Believe it or not, some agencies do not offer apartments as housing alternatives. Other times, the town you will be working in does not have anything better to live out of than a motel 8.

Rarely, you may be able to negotiate a housing stipend but be aware of low-ball offers. For example, a fellow traveling Nurse Practitioner was offered $2000/mo housing stipend for the San Francisco Bay Area! In somewhere like Texas, that goes a long way. However, the average agency spends $4000/mo on housing for locum tenens nurse practitioners in the Bay area, since housing is extremely expensive there! Luckily, I was able to provide her with that insight and she re-negotiated her housing stipend.

 

 

What We Wish Recruiters Knew

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Working as a locum tenens nurse practitioner, I have developed many great relationships with agency recruiters. Speaking with other traveling nurse practitioners, we can agree that there are some things we wish our recruiters knew.

 

  • Do not call us more than once per day: It is YOUR job as a recruiter to be on the phone and talk to potential locum tenens providers. It is OUR job to be working in a medical facility taking care of patients. So if we do not answer your first call, we are likely working and will be unable to reach you until after hours or during our lunch break. When we check our phones at the end of the day and have 5 missed calls from you, it will only enable us to avoid you more.

 

  • Do not plan on talking to us for more than 5 minutes: I do not know how many times I have returned a call to find out if there are any new job opportunities, and ended up on the phone for 30 minutes. Often it was because the recruiter was reading a list of jobs that do not even match my interests or specialty. If you are lucky that we called you back, please keep the phone calls concise.

 

  • We love communicating via email: The most successful recruiters are the ones that email us job opportunities. That way we have several options to review and all of the details of the assignments are on one page. This prevents us from having to spend 30 minutes to 1 hour on the phone with you. Also, if I want to recommend someone for that job, I can easily forward that email with details to my peers.

 

  • We are educated: Clearly we went to school for many years to be able to take care of our patients. This means you will not be able to convince us to take a job that does not meet any of our interests or specialties. When you act like you know what is better for us than ourselves, it will only make us want to work with you even less.

 

  • Please put us first: Although the agency makes their income from the sites they place providers with; we want to feel like we are your priority. Put our needs first and if an issue arises with the site, be on our side. We will continue to work with you when you make us feel like the most important aspect of locum tenens.

 

  • Be available and responsive: The most frustrating aspect of locum tenens is when you are unable to reach your recruiter. We know life happens, but it shouldn’t take long to respond to an email or phone call. Especially when a potential job opportunity falls through, it is better to keep us updated than to become unreachable. This will only make us want to move on.

 

Is there anything else you wish your recruiters knew?

New Locums in Virginia

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I began my new assignment in Virginia and I am really enjoying it! Prior to my start date, the site seemed extremely excited for me to come. The medical director even called me on the day I arrived to Virginia to make sure I was okay!

The first week I was given orientation. I quickly learned how important patient outcomes and satisfaction was to this company. The CEO stated that “everyone is serving a patient or serving someone who is.”

New patients and follow up ER visits are 40 minute appointments; follow-ups are 20 minutes. This clinic focuses on geriatric patients, so the patients follow up minimally every month. There is an onsite pharmacy that provides pre-packaged 90-day supply of commonly used medications. Research shows that there is a lag time of 3-5 days between 30-day medication refills for many patients. Providing 90-day supply medications helps facilitate medication adherence.

Each new patient goes through a comprehensive assessment and plan which includes: new member orientation, obtaining prior medical records, baseline EKG, baseline labs, baseline ECHO, bleeding and bruising screening, depression and alcohol screening, and vibration perception threshold. The company believes in investing in the patient before they become sick.

There is onsite acupuncture and tai chai. Acupuncture is used for neck and back pain, anxiety, insomnia, and migraine headaches. Tai chai is done to help this population strengthen their balance to avoid falls. There are also on-site specialists such as Cardiology, Podiatry and Optometry.

The goal is to provide comprehensive and valuable primary care, to keep patients out of the hospital. Weekly huddles are done amongst the providers in the clinic to discuss ways they can improve patient outcomes. The average wait time for the patient between checking in and seeing their provider is 5 minutes! The patients each have a life card, in which they use to check in. This card contains their insurance information, allergies, personal contact information, and their last EKG test to provide to other providers if necessary.

This is a large umbrella organization that has many geriatric clinics in multiple states. If all goes well, we agreed that I can always help cover for them in other states. They actually originated from Miami, Florida, so it may be a good option for me if I ever decide to settle back down in Miami. Lastly, everyone that works here is super friendly, hardworking, and easy going. They have welcomed me with open arms and I am looking forward to working with them for the next few months.

After working in very busy practices in California for the majority of the year, I was afraid I would no longer be as passionate about my job as I used to be. I am glad to find that there are still plenty of great medical practices to work at. This is just another reason why working in locum tenens is so great!

5 Things I Love About Locum Tenens

  • Travel: The best part of working in locum tenens is the travel! I am able to explore different parts of the country without having to pay for anything out of pocket. You get to really explore a town when you live there for several months versus just visiting for 3 days. I have friends and family that live all over, so it’s really nice to be able to meet up with them occasionally.
  • Flexibility: Working as a traveling nurse practitioner, I can request as many vacation days off as I want. I usually present these dates to a site before starting, to make sure there are no surprises. I am also guaranteed to have all vacation days off. If I do decide to work on holidays, I am offered holiday pay. If I decide to work four 10 hour shifts or only 32 hours a week, the site will likely accommodate me. 
  • Great Pay: By working locum tenens, I make more than I would make working at a full-time job. When I began working locum tenens, I started off immediately making $10/hour more than I did at my perm job. I am also guaranteed paid for any overtime hours worked, which is nice since most salary employees work more than 40 hours a week without overtime pay.
  • Learning: Part of the appeal of doing locums is working in various environments. Depending on the type of facility and patient population, I am constantly being challenged and learning something new. The physicians at these sites are often welcoming and open to providing a quick consult if needed.
  • Miles/Points: As someone who loves to travel, collecting airline miles and hotel points throughout my locum tenens assignments is a plus. I have joined most reward membership programs, and am constantly accruing miles/points. I am then able to use these miles to fly free during my vacations. In addition, my multiple hotel stays have gotten me top elite status, which comes in handy when I stay at these hotels during my travels abroad (free breakfast and room upgrade perks etc.).

 

What are some reasons you enjoy working locum tenens?

Virginia

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Since my Texas government gig didn’t work out, I needed to find an assignment to start ASAP. The only active licenses I had at the time were: Texas, California, and Florida.

For some reason, the Texas market for locum tenens positions had been dry all summer. I knew going back to California was not an option- as I promised myself I wouldn’t go back until at least next year. Lastly, Florida has a high density of Nurse Practitioners, so they do not have many traveling assignments available at any given time.

When I had thought the Texas assignment was a for sure thing, I slowly began applying for licenses in North Carolina and Virginia. I was in no rush because I thought I wouldn’t need to utilize either one of them until the following year. Lesson learned: always have new state licenses that you are working on.

Fortunately, the same day that I had turned down the Texas assignment, my Virginia license came in! During that same week, I had already had an interview with a site and accepted their offer!

They wanted me to start the following week, so everything happened pretty quickly, which I was grateful for. It wasn’t until I was on my way to Virginia that I realized Virginia requires a furnishing license to prescribed ALL medications, not just controlled substances like a few other states do.

I immediately freaked out thinking the site wouldn’t want me to start right away anymore. I was disappointed that no one from the agency noticed I was missing that licensing! Hello licensing and credentialing team! I was also upset at myself for forgetting to check the “Licensing” tab on my blog, which includes a chart of all required licenses per state. Of course the furnishing license requirement was on there, but I forgot to look!

After voicing my concerns to my recruiter, she informed me that the site still wanted me to proceed with my initial start date. Apparently the site does not allow any of their providers, including both physicians and nurse practitioners, to prescribe their own medications for the first 2-4 weeks. They have an onsite pharmacy in which providers dispense medications, so they only allow you to prescribe after formal training. In the mean time, any prescriptions I would need to order for my patients, would be placed by my supervising physician.

My family was surprised at how quickly I was leaving when I accepted the job, but it didn’t surprise me. My friends thought I was crazy when I was making my way up to Virginia without any official lodging details until the day of my arrival. To me, this was all a normal course of being a traveling Nurse Practitioner, where flexibility is always key!

Questions from Readers

Each month I will include a blog entry answering some of the most common questions I get from readers about locum tenens as a nurse practitioner. Feel free to comment any questions you have or email me at travelingNP.com@gmail.com.

 

What is one thing you would recommend for new traveling Nurse Practitioners?

I would recommend for them to be open-minded. As an outsider, you think any job in any location is at your disposal. In reality, given the time frame of your search you may be limited to rural opportunities or more urgent care clinics vs family practice sites.

If you are open-minded to the location, you will have many options to choose from. If you are open-minded to the type of setting, you will have many options to choose from.

I know a lot of new traveling nurse practitioners that tell their recruiters they are only interested in going to one city in a specific state. They are often kept waiting for several months until something becomes available. If you were to tell your recruiter that you are open to the entire state, then you are more likely to find something quickly.

Government Sites

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Working as traveling nurse practitioners, we often consider working with government sites because we can use any state license. Some examples include the VA, naval and air force bases, and Indian Health Services (IHS). Unfortunately, government locum tenens assignments have a few drawbacks. The comments below are more specific to VA and military bases (not IHS).

  • The pay is usually lower than working in the private sector (including some but not all IHS).
  • The time for credentialing is often longer than other jobs – can range from one month to one year!
  • Travel benefits are a possibility but not as all-inclusive, as seen with most traveling positions.
  • They usually require a 6-month to 1 year commitment.

I had accepted a locum tenens nurse practitioner position working with an air force base in Texas this past summer. I knew someone who had worked there previously, so I was really interested in taking a break from primary care. The job entailed performing physical assessments of air force members transitioning into civilians.

After multiple complex stunts working in California, as I detailed in my blog previously, I was looking forward to something so simple. I lucked out because usually the site requires a 6-month commitment, but since their contract with the agency was going to terminate before the end of the year, they were allowing me to commit for only 3 months.

I even decided that the pay cut was worth it. I was going to be making $10/hour less than I usually make. I even decided that not getting travel reimbursement wasn’t a big deal, nor the fact that I was only getting an $800/month stipend to pay for my apartment. Luckily, Texas has really cheap housing in comparison to other states like California. Yet, it is challenging finding short-term lease apartments for cheap, so I was likely going to spend an extra $300/month out-of-pocket. Call me crazy?!

The agency I was working through, told me credentialing would take only 2-4 weeks. I knew from a few friends that it could actually take much longer than that. After accepting the assignment, I didn’t need to start for another 2 months, so I thought that would be plenty of time. After each month, the agency would tell me that my security clearance didn’t come through yet, and it may be another 2-4 weeks. After 3 months, I decided I did not want to wait anymore. I had friends that were told the same thing before, but their security clearance wasn’t granted until 6 months later!

I was easily able to end my contract since the agency couldn’t follow through with their (2-4 weeks of credentialing) promises. I am not sure if I will try to work with them in the future, as their time frame for credentialing can be unpredictable. My belief that everything at the government level takes so long for no reason was confirmed. In addition, I typically do not like committing to an assignment for more than 3 months. In the future, I wouldn’t mind doing IHS, as their credentialing usually takes 1 month or less.

If you’re interested in working in the government sector, be aware that you likely won’t be able to start right away, unless it is with an IHS.

Is California a Curse? – Part 2

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A few months ago, I discussed some challenges I was facing applying for licenses in other states after already having a California license.

It turned out that one of the licenses I applied for (Virginia) – only required verification of my Nurse Practitioner license from the original state I was licensed in. This state happened to be Florida, which offered a quick turn-around.

On the other hand, one of the other licenses I applied for (North Carolina) – required I submit verification of my Nurse Practitioner license from ALL states I have ever been licensed in (both active and inactive).

After 3 months of my initial application with North Carolina, I have received my RN license, but the Nurse Practitioner license is still pending. Do you want to guess what is holding up my NP license? They still have not received verification of my California license. After paying $100 for the California verification, you have to wait another 2-3 months. At this rate, I doubt I will have the North Carolina license before winter hits

Some states, such as Washington, allow you to apply for your Nurse Practitioner license once you have a temporary RN license. However, North Carolina only allows you to apply for an NP license once you have a permanent RN license. So unfortunately, this causes a delay in the application process.

As a lesson learned, my recommendation to you other traveling Nurse Practitioners with a California license, is to give yourselves about 3 months to obtain new licensure. It always helps to do some research before applying for a new license to find out if they require verification of ALL of your licenses or just your first and/or most recent one.

Europe Trip 2016

As a traveling nurse practitioner, it’s difficult to plan out your vacations unless it’s truly last minute, because you have no idea where you will be later on in the year. I usually just plan my trips for the year and make my locum assignments work around them.

Before my next assignment, I had a planned trip to Europe with my family. We decided to go to London for the first time, since it finally peaked our interest after watching the show “The Tudors”. I had an amazing time in London; it definitely exceeded my expectations. There is just soooo much to do there!

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We enjoyed going to Hampton Court Palace to see where Henry VIII once lived. We also loved the National Portrait Gallery because we were able to see all of the portraits of the Tudors and Stuarts and other royal families that we were used to seeing in books or online. I loved visiting Westminster Abbey, Shakespeare’s Globe, and the British Museum (where I got the see the Rosetta Stone!).

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London was a lot more diverse than I expected. They had a lot of Arabs, Indians, Africans, and Eastern Europeans. At the same time it was very clean and people were nice and respectful. Using public transportation was straightforward. Fortunately for us, the pound went down after Brexit, so everything was pretty affordable. We enjoyed having afternoon tea in London as well.

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We continued our trip to Ireland, hoping that being in the countryside would provide us with much needed rest and relaxation. Dublin was also pretty diverse – with plenty of immigrants from Eastern Europe. It was interesting to learn about Ireland’s history and how the English preferred to settle in America over Ireland, because there were constant uprisings and wars throughout Ireland.

 

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We lucked out with some great weather in Ireland, as sunshine is pretty limited there. The picture above is us visiting St. Patrick’s Cathedral. The grass in Ireland was just as green as we imagined it to be. My favorite part was visiting the Cliffs of Moher (pictured below).

 

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We ended the trip in France, since we like to go every year, as we have family that lives there. Paris is my favorite city in the world so I enjoyed promenading the Champs Elysees and eating macaroons any chance I got. We rode bikes around the Notre Dame and along the Seine River.

 

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We wanted to visit a new section of France, so we agreed to go to Normandy. We took a day trip to Isle St. Michel, which is a magnificent church on top of an island. Sometimes the tide is high that you can only access the island via boat, other times you can take a trolley over the bridge.

 

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After a fun 3 week trip to Europe, I returned home to start my next locum tenens adventure!

 

Questions from Readers

Each month I will include a blog entry answering some of the most common questions I get from readers about locum tenens as a nurse practitioner. Feel free to comment any questions you have or email me at travelingNP.com@gmail.com.

 

  • Would I be able to change specialties while working in locum tenens?

 

Many people assume that just because you are a Family Nurse Practitioner and have only worked in primary care, that you cannot work in a different setting. While working in locum tenens, as long as you are open to learning, you gain a variety of skills set. There are often urgent care and occupational health facilities that are more than happy to hire a locum tenens nurse practitioner that has only worked in primary care. In this case, they are willing to work with you to adjust to the new facility type.

If you have work experience solely in a specialty, such as orthopedics or dermatology, and you want to start working in a family practice; you will have to consider yourself as a ‘beginner’. I know nurse practitioners that transitioned from specialty practice to family medicine and they were easily overwhelmed. The reason is because usually with specialty practice you are only treating one problem vs in primary care you are addressing several problems in a limited amount of time. In this case, I would recommend you find a locum tenens placement that will start you off slow and has a long orientation process.

Let’s say you want to jump from primary care to a specialty such as Urology. Depending on the site, they are willing to hire you if you commit to a long-term assignment (likely 6 months-1 year+), since they will be providing you with plenty of training. Anything is possible in locum tenens, just be sure to ask the right questions!